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Liberia's puzzle: How did the new Ebola patient become infected?

More than 7 weeks after Liberians took to the streets to celebrate that their country had been declared free of Ebola, the deadly virus has come back, raising fears of a resurgence. The body of a 17-year-old boy who died recently has tested positive for Ebola, Liberian deputy minister of health Tolbert Nyenswah announced yesterday. The big question now is how he became infected.

The World Health Organization (WHO) has sent a team to investigate the case and trace all contacts in collaboration with the Liberian health ministry. "Obviously this is not good news," says Tarik Jasarevic, a spokesman for WHO. But he also pointed out that a sample was taken from the body after death, an Ebola test was done, and when it came back positive, a team was dispatched immediately to conduct a safe burial. "This shows clearly that Liberia is in a much better position than it was a year ago," Jasarevic says.

"It is really important to understand how this person got infected," Jasarevic adds. The patient's hometown of Nedowian is close to Liberia’s capital Monrovia, and far away from the border regions with Sierra Leone (SL) and Guinea, the two countries where the virus is still spreading. At a meeting about the case held this morning at Liberia's ministry of health, some suggested that the boy might have traveled within Liberia the past 2 weeks, says Philippe Le Vaillant, a program manager for Liberia at Doctors without Borders currently working in Monrovia, who attended the meeting. Travel inside the country would not explain how he became infected, however, because Liberia is officially Ebola-free. "There is no known source of infection and there's no information about him traveling to Guinea or SL,” a spokesperson for the ministry of health wrote in an email.

It's possible that the disease was recently reimported into the country and that the boy came in contact with patients who haven't been reported—a worrying scenario because it could lead to further spread. Interviews with his siblings will hopefully yield more information soon, Le Vaillant says.

Health officials seem to have missed the case initially because the patient tested positive for malaria, says Le Vaillant, which may have kept them from doing an Ebola test. "Malaria cases are increasing here now and the symptoms can be very similar to an Ebola infection,” he says.

If more Ebola cases are found, they could be treated in the Ebola Treatment Units (ETUs) that are still running. Liberia was officially declared free of the disease on 9 May, 42 days after the last patient, a woman, fell ill. But some ETUs have remained open to take in the many suspect cases that are still being reported. Since the 9 May declaration, none of those had tested positive for the Ebola virus.